Gastroesophageal Reflux Disease Management

Diagnosis and Treatment

• The American College of Physicians recommends that patients with severe erosive esophagitis (LA-D) should undergo a follow-up endoscopy after 8 weeks (2 months) of proton pump inhibitor (PPI) therapy to confirm healing and rule out Barrett's esophagus 1, 2
• The Los Angeles classification system defines severe erosive esophagitis as grade B or higher, which requires endoscopic surveillance 1, 2, 3

Follow-up and Surveillance

• If the follow-up endoscopy is normal (healing), routine endoscopy is not indicated, and PPI therapy can be continued at the lowest effective dose 1, 2, 4
• If Barrett's esophagus is detected, surveillance endoscopy should be performed every 3-5 years for patients without dysplasia, and more frequently for those with dysplasia 1, 3, 4
• The risk of developing Barrett's esophagus in areas of healed esophagitis is approximately 6% 5

Long-term Monitoring

• After a single normal follow-up endoscopy, further routine endoscopy is not recommended, even if the patient continues PPI therapy 1, 2, 3
• The probability of developing stricture, Barrett's esophagus, or cancer after healing is 1.9%, 0%, and 0.1% over 7 years, respectively 5